Disclosure of Complications

Abstract

Adverse events in medicine are an inevitable consequence of a service that relies heavily upon humans. Estimates of the frequency of medical errors vary widely; however, the key publication, produced by the Institute of Medicine in 2000, To Err Is Human: Building a Safer Health System estimated the number of medical errors that occur in the Health Service in the USA at over one million annually; 10 % of these (100,000) were considered to cause patients serious harm. Further studies have suggested that over half of medical errors are not disclosed. The ethical and professional obligation placed upon medical professionals towards full disclosure is clear, with bodies such as the American Medical Council and General Medical Council recommending full and open disclosure. The apparent lack of disclosure is based on the fundamental issue that physicians have a conflict of interest: their professional and ethical responsibilities to the patient, and their self-interest. This chapter will explore the ethical and professional imperative towards full disclosure, examine barriers to that disclosure, and examine some of the uncertainties surrounding the decision to disclose.